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Background Neoatherosclerosis, a prominent contributor to in-stent restenosis (ISR), persists as a formidable challenge during percutaneous coronary intervention. Excimer laser coronary atherectomy (ELCA) and embolic protection devices may help reduce coronary flow disturbance from procedure-related distal embolization. Case summary A 71-year-old man experienced in-stent neoatherosclerosis rupture–related non-ST segment elevation myocardial infarction. Multidisciplinary intracoronary imaging, including intravascular ultrasound and optical coherence tomography (OCT), suggested that the ISR was caused by a neoatherosclerosis rupture that can potentially lead to distal embolization. Excimer laser coronary atherectomy (fluence, 45 mJ/mm2 and frequency, 25 pulse/s) using a 1.7 mm concentric catheter was performed with distal protection using Filtrap (Nipro Corporation, Tokyo, Japan), which significantly reduced the volume of the neoatherosclerosis. However, subsequent ELCA on the highest setting (fluence, 60 mJ/mm2 and frequency, 40 pulse/s) led to a filter no-reflow phenomenon, although OCT revealed a further effective vaporization of the neoatherosclerosis and an apparent reduction of soft tissue compatible with the thrombus. After removing the embolic protection device, drug-coated balloon angioplasty provided optimal results without coronary flow disturbance. Discussion Excimer laser coronary atherectomy reduces soft plaque and thrombus burden, which can reduce the occurrence of distal embolization in select cases. In the case of this patient, procedure-related distal embolization may have been induced by the heightened photomechanical effects resulting from the use of the highest setting in ELCA under increased intracoronary arterial pressure caused by continuous saline injection during ELCA. Concomitant distal protection during ELCA may be more feasible for preventing coronary flow disturbance in patients with a large amount of neoatherosclerosis. [ABSTRACT FROM AUTHOR]

Background A large thrombus burden in patients with acute myocardial infarction is associated with worse outcomes. Although various methods of thrombus aspiration have been described, there is a potential limitation in the mechanism of eliminating a thrombus with only the use of an aspiration device. In this report, we present a novel method of retrieving massive thrombus using a guide extension catheter and a filter device. Case summary An 80-year-old man was diagnosed with anterior ST-elevation myocardial infarction (STEMI). Emergency coronary angiography revealed that the left anterior descending artery (LAD) showed an acute thrombotic occlusion in the mid-section. The percutaneous coronary intervention was performed to recanalize an occluded LAD. Although thrombectomy using an aspiration catheter and a guide catheter extension system was performed repeatedly, only a small amount of the thrombus was retrieved, and the LAD was still occluded. Therefore, we planned to remove the large thrombus burden by capturing the entire thrombus between the tip of the guide extension catheter and distal protection device, followed by pulling them out of the guide catheter together. A large amount of red thrombus, which adhered to the axis of the filter device, was successfully retrieved. The occluded LAD was successfully recanalized without balloon dilatation or stent implantation. Discussion Although a variety of aspiration devices are available, removal of large coronary artery thrombi with the use of an aspiration catheter alone can at times prove difficult. To solve this problem, we developed a novel technique for retrieving large thrombi. This method is effective in removing refractory thrombi for the treatment of STEMI patients. [ABSTRACT FROM AUTHOR]

Background Minimally invasive percutaneous transluminal renal artery stenting (MIPTRS) is a method that prevents complications to the greatest extent possible. The present study aimed to investigate the safety and efficacy of MIPTRS performed in cases of renal artery stenosis with an estimated glomerular filtration rate (eGFR) ≤ 45 mL/min. Methods Cases of patients who underwent MIPTRS at our hospital between December 2010 and June 2015 in whom eGFR was ≤ 45 mL/min were retrospectively analysed. MIPTRS was performed as follows: 1) using a 4Fr sheathless guiding catheter in a trans-radial approach and 2) using a guiding catheter non-touch technique. The amount of contrast agent used was maintained at ≤ 10 mL with 3) carbon dioxide enhancement and 4) intravascular ultrasound guide stenting, and 5) a distal protection device was used. Results MIPTRS was performed in 22 patients (32 lesions). The pre-MIPTRS creatinine level and eGFR were 2.01 ± 0.88 mg/dL and 29.2 ± 9.0 mL/min/1.73 m 2 , respectively. On postoperative day 2, they were 1.78 ± 0.73 mg/dL and 35.1 ± 12.3 mL/min/1.73 m 2 ; at 1 month after the procedure, they were 1.80 ± 0.74 mg/dL and 33.3 ± 12.3 mL/min/1.73 m 2 . Creatinine level did not change significantly, but eGFR was significantly elevated after versus before the procedure, both 2 days later ( p < 0.01) and 1 month later ( p < 0.05). Conclusion The results of this study demonstrated the usefulness of MIPTRS for protecting renal function. This method can be safely used in patients with decreased renal function. [ABSTRACT FROM AUTHOR]

We present the case of an 82-year-old male patient with unstable angina pectoris referred for percutaneous coronary intervention in the saphenous vein graft (SVG) to left circumflex coronary artery. An everolimus-eluting cobalt chrome stent was successfully deployed, using an embolic protection device with balloon occlusion and aspiration system. During the procedure of aspiration thrombectomy, the deployed stent unexpectedly collapsed. We re-dilated the collapsed stent using the same distal protection and aspiration system. However, the stent collapsed again during the aspiration procedure. As we could successfully re-dilate the collapsed stent using the same balloon occlusion and aspiration system after pulling the guide catheter out from the ostium of SVG, we concluded that the collapse of the stent was caused by the excess negative pressure generated by the distal occlusion and aspiration procedure under the completely wedged guide catheter into the ostium of SVG. We believe this is the first report of stent collapse due to excess negative pressure during aspiration thrombectomy. < Learning objective: Since the radial strength of coronary stents is high enough, deployed stent collapse is a rare complication. This case report describes a novel mechanism of stent collapse, which was caused by the excess negative pressure generated by the distal occlusion and aspiration procedure in saphenous vein graft intervention. To avoid this type of complication, in using distal protection devices, the side-hole guide catheter should be used, or the guide catheter should be carefully manipulated not to be wedged.> [ABSTRACT FROM AUTHOR]

To describe an innovative distal protection technique, ' sheath rendezvous method', during endovascular treatment for subclavian arterial occlusions. 4.5F and 6F guiding sheath were inserted from left brachial and common femoral artery, respectively. 0.014″ guidewire retrogradely passed through occlusion and into antegrade sheath to establish a pull-through system. 3.0 mm balloon was used to expand occlusion and anchor to deliver retrograde sheath into antegrade one. Both sheaths locked by balloon dilatation crossed occlusion until antegrade sheath passed over lesion. Balloon expandable stent was delivered within antegrade sheath. Sheath was removed, and stent was implanted. We obtained an excellent outcome without complications. [ABSTRACT FROM AUTHOR]

Purpose: Contralateral carotid occlusion (CCO) increases the risk of carotid endarterectomy (CEA). We determined the outcome of carotid angioplasty and stenting (CAS), an alternative to CEA, in the setting of CCO through an independent analysis of imaging and clinical outcome.Materials and Methods: Medical records of 26 consecutive patients with CCO who underwent CAS by a single operator using the same procedural protocol (with distal protection and closed-cell stents) were retrospectively evaluated. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores before and after CAS, periprocedural complications, and the restenosis rate were analyzed by independent stroke neurologists who were not involved in the care of the patients.Results: The median mRS score for the 26 patients was 1 (range 0-5) before and after CAS. All of the patients underwent clinical and imaging follow-up (mean 19.5 ± 14.3 and 11.6 ± 11.2 months, respectively). Thirty-day mortality/permanent morbidity rates were 0 %. One patient had hyperperfusion syndrome and was managed medically without sequelae; however, he had stent occlusion after 30 days, resulting in a decline in his mRS from 4 (preprocedure) to 5. Otherwise, there was no decline in mRS during the post-discharge follow-up.Conclusion: According to an independent analysis of this single-operator series, CAS is safe and effective for the treatment of patients with CCO. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a dise ase characterized by inflammation in the arterial wall. Atherogenesis is dependent on the innate immune response involving activation of Toll-like receptors (TLRs) and the expression of inflammatory proteins, those may lead to acute coronary syndrome (ACS). We investigated the expression level of TLR-4 in ACS, as compared with TLR-2 and patients with stable angina. Fifty-eight consecutive patients who underwent primary percutaneous coronary intervention (PCI, n = 29) because of ACS and elective PCI ( n = 29) because of stable angina using a filter-device distal protection device system were prospectively analyzed. mRNA levels of TLR-2 and TLR-4 in debris containing various inflammatory tissues entrapped in the filter device were altogether analyzed using real-time PCR. There were no significant differences in age, sex distribution, between stable angina and ACS groups. TLR-4 expression levels were higher in patients with ACS than in patients with stable angina. TLR-4 might play a more important role than TLR-2 in atherogenesis, especially in ACS. [ABSTRACT FROM AUTHOR]

Objectives This study sought to determine whether pre–percutaneous coronary intervention (PCI) plaque characterization using near-infrared spectroscopy identifies lipid-rich plaques at risk of periprocedural myonecrosis and whether these events may be prevented by the use of a distal protection filter during PCI. Background Lipid-rich plaques may be prone to distal embolization and periprocedural myocardial infarction (MI) in patients undergoing PCI. Methods Patients undergoing stent implantation of a single native coronary lesion were enrolled in a multicenter, prospective trial. Near-infrared spectroscopy and intravascular ultrasound were performed at baseline, and lesions with a maximal lipid core burden index over any 4-mm length (maxLCBI 4mm ) ≥600 were randomized to PCI with versus without a distal protection filter. The primary endpoint was periprocedural MI, defined as troponin or a creatine kinase-myocardial band increase to 3 or more times the upper limit of normal. Results Eighty-five patients were enrolled at 9 U.S. sites. The median (interquartile range) maxLCBI 4mm was 448.4 (274.8 to 654.4) pre-PCI and decreased to 156.0 (75.6 to 312.6) post-PCI (p < 0.0001). Periprocedural MI developed in 21 patients (24.7%). The maxLCBI 4mm was higher in patients with versus without MI (481.5 [425.6 to 679.6] vs. 371.5 [228.9 to 611.6], p = 0.05). Among 31 randomized lesions with maxLCBI 4mm ≥600, there was no difference in the rates of periprocedural MI with versus without the use of a distal protection filter (35.7% vs. 23.5%, respectively; relative risk: 1.52; 95% confidence interval: 0.50 to 4.60, p = 0.69). Conclusions Plaque characterization by near-infrared spectroscopy identifies lipid-rich lesions with an increased likelihood of periprocedural MI after stent implantation, presumably due to distal embolization. However, in this pilot randomized trial, the use of a distal protection filter did not prevent myonecrosis after PCI of lipid-rich plaques. [ABSTRACT FROM AUTHOR]

Objective: Cerebral protection device utilization during carotid artery stenting (CAS) has been shown to decrease risk of perioperative stroke. The two most commonly used devices are distal filters and proximal protection devices, which allow blood flow cessation or flow reversal. The goal of the present study was to examine anatomic and morphologic characteristics of the treated lesions using each type of cerebral protection device and compare clinical 30-day adverse event rates between the two cerebral protection groups. Methods: We conducted a single-center, retrospective review of consecutive CAS cases with proximal protection devices that were matched with CAS cases using distal filter protection devices based on indication (symptomatic vs. asymptomatic), age, and gender. We reviewed clinical, anatomic, and morphologic characteristics of the stented lesions in cases of proximal or distal protection and also studied the rate of major adverse events within the first 30 days after the procedure. Results: We identified a total of 70 patients treated with proximal protection devices who were matched in a blinded fashion to 70 cases with distal protection. There was a significantly higher number of high-risk lesions in patients who had CAS using proximal protection devices (P = 0.009). There was no significant difference in overall frequency of 30-day adverse outcomes (transient ischemic attack/stroke/reperfusion hemorrhage/death) between the two groups (P = 1.0). Conclusions: Our study is the first attempt (to our knowledge) to review and compare anatomic and morphologic characteristics of the stented lesions in cases of proximal versus distal protection for CAS. Our data indicate that in properly selected patients both approaches could be equally safe and effective. [ABSTRACT FROM AUTHOR]

Purpose: To compare the performance in vitro of 6 distal protection filters (DPFs) on the basis of filtration ability and effects on pressure gradient and vascular impedance in a flow model of the internal carotid artery (ICA). Methods: Six DPFs (Accunet, Angioguard, FilterWire, Gore Embolic Filter, NAV6, and SpiderFX) were evaluated in a physiologically realistic flow loop. A blood analog was heated to body temperature and circulated by a pulsatile pump outputting a time-varying flow rate representative of the ICA. The ICA flow model was a highly curved tube representing a challenging site for filter deployment. The DPFs were deployed at the apex of the curved segment, and 2 sizes of microspheres (143 and 200 µm) were injected to simulate embolization. The capture efficiency, pressure gradient, normalized pressure gradient, and vascular impedance were calculated. Results: The Gore filter had high capture efficiency (143 µm: 99.97%; 200 µm: 100.00%) with relatively small increases in pressure gradient (143 µm: +27%; 200 µm: +20%) and vascular impedance (143 µm: +23.4%; 200 µm: +6.1%) after particles were injected. Spider had the lowest capture efficiency (143 µm: 1.50%; 200 µm: 19.34%, p<0.0005), while NAV6 (143 µm: +916%, p<0.0005) and Accunet (200 µm: +179%, p<0.0005) yielded the largest pressure gradient increases. Conclusion: A bench-top flow apparatus exhibiting physiologically realistic conditions was developed by combining pulsatile flow and a body temperature blood analog. Using microspheres larger than the pore size of most of the DPFs, the device-wall apposition has an important effect on the overall filter performance and the global fluid dynamics in the flow model. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background: The use of distal filter protection during primary PCI increases procedure complexity and may influence lesion treatment and stent implantation. Methods: The STEMI patients were assigned to distal protection (DP) (n = 312) or conventional treatment (CT) (n = 314). Clinical follow-up was performed after 1, 6, and 15 months, and angiographic follow-up after 8 months. All target lesion revascularizations (TLRs) were clinically driven. We report the pre-specified end points of stent thrombosis according to the criteria of the Academic Research Consortium, TLR, and reinfarction after 15 months. Results: The total number of stent thrombosis was 11 in the DP group and 4 in the CT group (p = 0.06). The rate of definite stent thrombosis was significantly increased in the DP group as compared with the CT group, with 9 cases versus 1 (p = 0.01). Clinically driven TLRs (31 patients vs. 18 patients, p = 0.05) and clinically driven target vessel revascularizations (37 patients vs. 22 patients, p = 0.04) were more frequent in the DP group. Conclusions: In primary PCI for STEMI, the routine use of DP increased the incidence of stent thrombosis and clinically driven target lesion/vessel revascularization during 15 months of follow-up. (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction Trial [DEDICATION]; NCT00192868) [Copyright &y& Elsevier]

im: Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may result in reduced myocardial perfusion, infarct extension and impaired prognosis. In a prospective randomized trial, we assessed the effect of routine filterwire distal protection on scintigraphic estimated infarct size. Methods and results: The effect of routine filterwire distal protection was evaluated in 344 patients with STEMI <12 hours undergoing primary PCI. Patients were randomized to distal protection with a filterwire or standard PCI. The primary endpoint was myocardial infarct size measured by Sestamibi SPECT after 30 days (%). Secondary endpoints included myocardial salvage, ST-segment resolution (STR), myocardial biomarker release and major adverse cardiac and cerebral events. Baseline characteristics including area at risk (estimated by Sestamibi SPECT) were similar. Final infarct size was not statistically different in the distal protection and the control groups (median [IQR], 6% [1-19] and 5% [1-14], P = .23). Also, secondary endpoints were similar in the two treatment groups. Conclusion: Distal protection with a filterwire performed as routine therapy in primary PCI for STEMI did not reduce myocardial infarct size. The study does not support routine use of distal protection in primary PCI. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although the benefit of distal protection (DP) during primary percutaneous coronary intervention (PCI) remains questionable, there appears to be efficacy in some clinical situations. We sought to identify in patients with ST-segment elevation acute myocardial infarction (STEMI) which clinical and angiographic characteristics might indicate the patient who will benefit from the use of a DP device. Methods: A series of 103 consecutive patients with STEMI undergoing primary PCI using DP were compared with 98 consecutive patients treated by primary PCI alone. Results: The overall rates of thromboembolic complications and achievement of optimal reperfusion (myocardial blush grade ≥2 and ST-segment resolution ≥70%), and infarct size, were similar between the 2 groups. However, DP use was associated with higher rates of optimal reperfusion in patients with right coronary artery (RCA) lesions (OR 2.45; 95% CI, 1.07 to 5.59; P =0.034), thrombus score ≥4 (OR 2.64; 95% CI, 1.07 to 6.50; P =0.034) or infarct-related artery (IRA) of ≥3.5 mm in diameter (OR 4.09; 95% CI, 1.02 to 16.40; P =0.047). In this population (RCA location, thrombus score ≥4, or IRA ≥3.5 mm), DP use reduced the risk of thromboembolic complications (64%, P =0.012, 45%, P =0.035 and 54%, P =0.050, respectively), resulting in a smaller infarct size (8.0±5.1 vs. 11.7±7.5, P =0.028, 13.1±8.8 vs. 17.4±10.0, P =0.026 and 15.5±10.8 vs. 22.1±10.1, P =0.042, respectively). Conclusions: The use of a DP during primary PCI may lead to a reduction of thromboembolic complications, subsequent higher rates of optimal reperfusion and reduced infarct size in patients with RCA culprit lesions, a large thrombus, or large IRA. [Copyright &y& Elsevier]

A 44-year-old male presented with multiple punctate acute infarcts of the vertebrobasilar circulation and a computed tomographic angiogram showing stenosis of the right vertebral origin. A digital subtraction angiogram demonstrated a new intraluminal filling defect at the origin of the stenotic vertebral artery where antegrade flow was maintained. This filling defect was accepted to be an acute thrombus of the vertebral origin, most likely due to rupture of a vulnerable plaque. The patient was treated with intravenous heparin. A control angiogram revealed dissolution of the acute thrombus under anticoagulation and the patient was treated with stenting with distal protection. Diffusion-weighted magnetic resonance imaging demonstrated no additional acute ischemic lesions. We were unable to find a similar report in the English literature documenting successful management of an acute vertebral ostial thrombus with anticoagulation. Anticoagulation might be considered prior to endovascular treatment of symptomatic vertebral stenoses complicated by the presence of acute thrombus. [ABSTRACT FROM AUTHOR]

*. The investigators of the RUBY study group are listed in the Appendix.Objective: To assess the safety and feasibility of the GuardWireTM system as an embolic protection device during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Background: Distal embolization occurs in approximately 15% of patients after primary angioplasty and is associated with reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Distal embolic protection could reduce the rate of embolic complications and improve outcome. Methods: 329 patients (mean age 60±12 years) were included: 278 (84.5%) with ST‐elevation myocardial infarction (STEMI), 50 (15.2%) with unstable angina/non‐STEMI and 1 (0.3%) with post‐infarction angina. Primary endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints were the magnitude of ST‐segment resolution at 90 and 180 min post‐procedure, myocardial blush grade, and angiographically visible distal emboli. Results: The GuardWireTM system was successfully positioned in 99% of patients. Complete ST‐elevation resolution (>70%) was observed in 28.5% immediately post‐procedure, and in 35.4% and 41.6% at 90 and 180 min post‐procedure. TIMI‐3 flow grade was achieved by 89.8% of patients after intervention and mean corrected TIMI frame count was 20.2±13.2. Grade‐3 myocardial blush was seen in 47.7% of patients and distal emboli were angiographically visible in 7.4%. Incidence of MACE at 30 days was 3.3% (death 1.2%; Q‐wave MI 0.3%; non‐Q‐wave MI 0.3%; coronary artery bypass graft 0.6%; repeat PCI 0.9%). Conclusion: The GuardWireTM system was successfully positioned in nearly all patients without complications. The use of this embolic protection device in ACS patients undergoing PCI was associated with low rates of distal embolization and 30‐day MACE. [ABSTRACT FROM AUTHOR]

Abstract: Background: Distal protection devices are increasingly used to prevent embolization during percutaneous coronary interventions (PCI) in saphenous vein grafts (SVG) and native coronary arteries (NV). During interventions with the Filterwire device we have observed reduced flow that is reversible following removal of the filter (filter no reflow, FNR), which might be erroneously interpreted as true no reflow and might be associated with reduced capture efficiency of the basket. Methods: We analyzed the incidence of FNR in 58 patients (60 lesions) at high risk of embolization undergoing PCI of either a SVG or a NV using the Filterwire (Boston Scientific, Natick, MA). Qualitative and quantitative angiographic analysis was performed, and the volume of collected debris was estimated using a photographic technique. Results: In our population, about 1/3 of the cases showed FNR, which was associated with angiographically visible filling defects within the basket, indicating macroembolism. However some patients (especially those undergoing vein graft interventions) showed filling defects without FNR, and some others FNR without filling defects. Thus we tried to understand the predictors of FNR: FNR was associated with higher amount of collected debris (36.97±42.98 mm3 vs. 11.31±18.47 mm3, p =0.005), was neither prevented by abciximab, nor predicted by high thrombotic burden, increasing stent volume or need for predilatation. When patient with and without angiographically evident macroembolisation were separately analyzed, a linear correlation of FNR with the quantity of debris was only apparent in the macroembolization group. Conclusions: Interventionalists should be aware of the “Filter No Reflow”, a common but reversible angiographic complication when the Filterwire device is used. Reduced flow seen during these procedures should be treated conservatively. Mechanical obstruction of the filter, but also other mechanisms (pharmacologically active debris? platelet aggregates?) play a role in this phenomenon. [Copyright &y& Elsevier]

Objective: To evaluate by MR diffusion weighted image (DWI-MR) the presence of new ischemic cerebral lesions after carotid artery stenting (CAS) and distal cerebral protection, in patients with internal carotid artery (ICA) stenosis >70. Methods: Sixty-seven CAS were performed under cerebral protection with a distal filter. Mean age of the patients was 68.3 years (range 37–86) and 42 patients (62.7%) were symptomatic. An EZ filter device was used in all cases. The mean length of the procedure was 22.2 minutes (range 8–110). All patients had a cerebral MRI done in the 3 days before CAS and a DW-MR (eco planar single shot, b= 1000 mm2/seconds) was done the day after. Results: As a consequence of the CAS, three transient ischemic attacks were observed. There was one minor stroke (1.5%) on day 21, but no major stroke, death or myocardial infarction in a 30-day period. DW-MRI after CAS showed 26 new silent ischemic lesions in 11 asymptomatic patients (16.4%). In six, they were multiple (range 2–5). Lesions were mainly seen in the ipsilateral medial cerebral artery (21); four in the posterior fossa, and one in the contralateral medial cerebral artery. Discussion: Although the use of distal cerebral protection was safe, new cerebral ischemic lesions, supposedly embolic, were observed in 16.4% of the patients. Although without clinical consequences in our series, their moderate high incidence should promote the investigation of safer techniques and devices. [ABSTRACT FROM AUTHOR]

Objective: Restenosis is a significant complication of stent placement. With coronary revascularization, drug-eluting stents have significantly decreased the incidence of in-stent stenosis and, therefore, the morbidity of the procedure. Restenosis is potentially a significant problem for neurovascular disease. We therefore report our institutional experience on the use of drug-eluting stents for the management of cerebrovascular insufficiency. Methods: Over a period of 2 years, 19 patients underwent extra- and intracranial drug-eluting stent placement for intra- and extracranial atherosclerotic disease. There were 12 males and seven females aged between 36 and 83 years old (mean 65). Thirteen heparin, three rapamycin, and three taxus-coated stents were placed. There were five intracranial internal carotid arteries, two intracranial vertebral arteries, three mid-basilar, six of vertebral artery origin and three middle cerebral artery stents utilized. No complications occurred. Results: There was one case of re-stenosis associated with recurrent symptoms requiring repeat drug eluting stent placement. No other patients have developed new or recurrent neurological symptoms. Five of six vertebral artery origin stents were placed with distal protection to prevent embolic complications. Conclusion: Intracranial and extracranial drug-eluting stent placement appears to be a safe alternative to the medical management of atherosclerotic disease of the vertebrobasilar and carotid systems. However, further randomized studies are needed to examine the effectiveness and safety of this procedure. [ABSTRACT FROM AUTHOR]

We report our early experience in using the PercuSurge GuardWire Plus system as a distal protection device in patients with acute coronary syndrome and acute myocardial infarction. Forty-three patients received percutaneous coronary intervention with the GuardWire Plus system. Thirteen had unstable angina, five had non-Q myocardial infarction and 25 had ST segment elevation myocardial infarction. Forty-one target lesions were in native coronary vessels and two were in saphenous vein grafts. Total occlusion occurred in 18 patients. The mean occlusion time by the distal protective balloon was 262.8±114.1 s. Preoperatively, TIMI 0 flow was present in 18, TIMI II flow in two and TIMI III flow in 23 patients. Post-operatively, TIMI II and TIMI III flow were established in two and 41 patients, respectively. All procedures were successful and the GuardWire Plus system was successfully deployed in all but two patients. There was no procedure-related major adverse clinical event. There was no major adverse clinical event at 30 days. There was no device-related complication. We believe that the GuardWire Plus system is safe and feasible in patients with acute coronary syndrome and acute myocardial infarction. [Copyright &y& Elsevier]

Abstract: Primary percutaneous intervention of saphenous vein grafts is associated with a high risk of distal embolization and no reflow. We report a case of acute myocardial infarction with a large intragraft thrombus, successfully treated with a technique combining thrombectomy with a 6Fr guiding catheter and distal protection with the FilterWire EZ. [Copyright &y& Elsevier]

Abstract: Particulate and histopathologic examination of atherosclerotic material collected during carotid artery stenting is presented, illustrating the limitations of current knowledge regarding the use of distal protection devices (DPD) during this novel vascular intervention. [Copyright &y& Elsevier]